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Not Just Back Pain: 5 Things You Need to Know About Sciatica

Back pain can be a real nuisance. It can potentially interrupt your ability to sleep, work, exercise, and affect other normal activities. However, that pain can be particularly worrisome and have a real impact on your life when it radiates down into your backside and leg, which is known as sciatica.

Sciatica is relatively common – about four out of 10 people will experience it at some point in their lives. Here’s what you need to know about that pain, including where it’s coming from and what you can do to ease it.

1. Sciatica is different than your typical back pain

“Back pain and sciatica pain are two completely different things,” said Dr. Guy Lee, an orthopedic surgeon with the Rothman Institute.

Low back pain is usually due to strain or injury to the muscles and ligaments supporting the back, with the pain focused in the muscles next to the spine, potentially moving to the buttocks.

“People can suffer back pain on and off for a variety of reasons, but once it radiates down your backside and leg, that’s sciatic pain,” he said. The sciatic nerve is made up of the lower nerve roots in the lumbar spine. When those nerves are irritated, the pain travels down the sciatic nerve, typically through the buttocks and down the back of the leg.

2. Sciatica is a symptom

“Sciatica is a fairly generic term – it implies inflammation with the sciatic nerve,” Dr. Lee said. “It's usually associated with a herniated disc.”

The discs are rubbery cushions between the vertebrae that build up your spine. “These discs are like a jelly donut,” Dr. Lee says, “and if the jelly leaks out, it can touch or compress the lumbar nerve, which leads to sciatica.”

“If the disc tears, the ‘jelly’ can leak out and if it’s on the right or the left side, it can compress the nerve,” he explained.

3. Certain positions and movements can worsen the pain

When the sciatic nerve becomes irritated or inflamed due to a herniated disc, the pain is generally worse when seated.

“When you sit, you’re putting pressure on the disc and the disc can push out a little more,” Dr. Lee said, noting that if he walks into an exam room to see a patient with a back issue and they’re standing, that patient is likely suffering from a herniated disc and sciatica pain – and they’re more comfortable standing.

Heavy lifting can make the pain worse and coughing can cause more of the “jelly” to leak out, potentially causing or worsening the pain.

4. There are some things you can do to ease the pain

If you have sciatica pain, you should be taking anti-inflammatories.

“If a herniated disc leaks out, anti-inflammatories can help alleviate the symptoms,” Dr. Lee said. “Sometimes a doctor will prescribe steroid medication – that can lower the inflammatory response, helping with the pain.”

Rest can also help, but relative rest is best.

“You can rest for a day or two, but you want to be up and stretching your leg,” Dr. Lee recommended. “We try to do nerve gliding exercises to keep the nerve moving so it doesn’t get stuck.”

When it comes to using heat or cold to ease the pain, Dr. Lee said there’s no science behind either one helping.

“Some people think applying heat can help. You can try heat or ice, whatever makes it feel better,” he said. Just be careful if you do try either one.

“With heat or ice, you can burn yourself if you leave it on too long,” Dr. Lee cautioned.

5. Severe sciatica pain should signal you to call your doctor

It’s very common to have a herniated disc, which leads to sciatica pain, but, according to Dr. Lee, a lot of the time, the herniation will go away on its own and get better with conservative care.

However, there are some signs that you may need more treatment. Those signs include weakness, especially in the leg, numbness beyond pain and bilateral symptoms.

“If the herniated disc is big enough, there can be more permanency if you don’t get it treated,” Dr. Lee said. In some cases, the herniated disc can get so large, he said, that it can cause a massive hernia, knocking out your bowel and bladder function.

“That’s a surgical emergency…once you start to have bowel and bladder issues, you can be left with permanent disability,” he said.